HomeMy WebLinkAboutForm 497- Yes on Measure D (2016-03-10)497 Contribution Report Amounts may be rounded to whole dollars.
Committee to Support San Rafael Libraries -Yes on Measure_
Date of
This Filing __ 3-_1_0_-2_0_1_6_
AREA CODE/PHONE NUMBER 1.0. NUMBER (if applicable)
Report No. ___ 1 __ _ 415-446-4222
STREET ADDRESS o Amendment
1000 Fourth Street, Ste. 600 to Report No. ____ _
-C-ITY-------------------=S:O=TA""':r==E=----,Z=OI=-P -=CO=-D=-E=--------i (expla in below)
San Rafael CA 94901 No. of Pages ___ 1.:....-__
1. Contribution(s} Received
DATE FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
RECEIVED (IF COMMmEE, ALSO ENTER 1.0 . NUMBER) CODE ..
Dirck W . Brinckerhoff IXI IND
D COM
3/9/2016 San Rafael, CA 94901 D OTH
D PTY
D SCC
D INO
0 COM
D OTH
D PTY
0 sec
D INO
D COM
D OTH
D PTY
D see
ReasonfurAmendment ________________________________ _
CITY CLERK'S 0
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
(IF SELF.EMPLOYED, ENTER NAME OF BUSINESS)
Real Estate Broker
HL Commercial Real Estate
··Contributor Codes
INO -Individual
AMOUNT
RECEIVED
$1,000
o Check if Loan
'4
Prov ide interest rate
o Check if Loan
%
Provide inleresl rate
o Check if Loan
'Jb
Prov ide interest rate
COM -Recipient Committee (other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
FPPC Form 497 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov